Lost Time Claims Specialist, Workers' Compensation

This is a fully remote position, open to applicants in Connecticut, +22 more states.

📋 Description

• Assesses and devises an action strategy for managing medical and indemnity benefits related to injury and occupational disease claims, ensuring they reach the most cost-effective resolution.

• Determines the outcome of claims using sound judgment by adhering to established policies, procedures, regulations, and guidelines.

• Collects facts through interviews with all parties involved and considers all aspects of the claim prior to making a decision.

• Takes recorded statements when required.

• Establishes eligibility for indemnity and medical benefits once salary information and medical treatment plans have been acquired and processed within the specified authority levels.

• Employs proactive reserving practices to maintain adequate case reserves that reflect the likely final outcome based on the current known circumstances throughout the claim's duration.

• Proactively identifies and develops investigations for potential subrogation recoveries whenever feasible.

• Consults with the assigned claim director, return-to-work specialists, nurse case managers, and medical and legal professionals regarding current and/or recommended treatment, litigation, or rehabilitation plans to ensure claim outcomes are both achievable and appropriate.

• Collaborates with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage claims costs and promote quality medical care.

• Works together with the injured worker, employer, assigned return-to-work specialist, and medical providers to facilitate a safe and timely return to work for the injured worker.

• Manages litigation related to claims, including expenses, by working in collaboration with and providing guidance to panel counsel throughout the claim’s lifecycle.

• Evaluates reports from external sources such as physicians, attorneys, and/or vocational rehabilitation experts to assess and adjust claim strategies as necessary.

• Assesses and negotiates claim settlements using interpersonal skills and technical expertise to achieve optimal results.

• Presents and summarizes claim details at internal team meetings, engages in discussions, and offers guidance as required.

• Consults with the assigned claim director when a loss becomes particularly complex or presents significantly increasing financial exposure.

• Adheres to established claims best practices concerning medical management, litigation, fraud/abuse, and recovery.

• Effectively and independently utilizes available resources to prioritize, organize, and complete work in a timely manner, meeting jurisdictional requirements, deadlines, and internal metrics.

• Develops presentations for special projects such as internal/external meetings and conferences when necessary.

• Participates in claim reviews, onboarding, etc., alongside the claim director, regional vice president, and other claims staff for our policyholders and agents.

• Actively collaborates with our policyholders to ensure alignment of goals and promote continuous improvement.

⛳️ Requirements

• A Bachelor’s Degree from an accredited institution is preferred.

• A minimum of three years of experience in workers’ compensation insurance is required.

• Capability to manage claims throughout the litigation process.

• Internal candidates must exhibit knowledge of Encova Best Practices guidelines and adhere to quality standards.

• A valid workers’ compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as necessary.

• Must successfully pass the claims adjuster license exam(s) assigned within 90 days of hire.

• Preference may be given to candidates with experience in managing claims across multiple states.

• Knowledge of workers’ compensation claims practices and laws, court procedures, precedents, and state statutes.

• Ability to apply logic and sound reasoning to identify alternative solutions for problem-solving.

• Exceptional written and verbal communication skills.

• Strong analytical abilities.

• Capacity to multitask and manage time efficiently and productively.

• Ability to work effectively both independently and as part of a team.

• Develop and maintain strong, effective relationships both internally and externally.

• Competence in working effectively in a paperless environment.

• Proficient in using laptops, claims management systems, and other standard business applications such as the Microsoft Office suite.

🏝️ Benefits

• Health, Dental & Vision Insurance

• Company-provided life and income protection plans

• Eligibility to participate in a company incentive bonus program

• 401(k) Retirement Plan - 100% company match up to 7% on annual salary

• Paid Time Off, Paid Holidays, and Floating Holidays

• Flexible Work Arrangements - Hybrid and remote depending on the role